25C-251 (84) � z5l
City of Northampton
r' Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
!. 212 Main Street • Municipal Building �t r
� Northampton, MA 01060
ACCESSORY STRUCTURE PERMIT APPLICATION
(For freestanding structures less than 200 sq. ft., at least 5 feet from any other structure)
Check#
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 6 't r092 2 5'%i2L i Telephone: y/L
2. Owner of Property:
Address: Telephone:
3. Status of Applicant:✓Owner Contractor
4. Structure Location: i�4=(Z G 2(,L,.-U 4-
Parcel ID:Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Property:Single or Two Family: Multifamily: Commercial: ✓
6. Description of Proposed Structure:
One Story Shed under 200 sq.ft.: Freestanding Deck under 200 sq.ft.,less than 30"above grade:
Size• l
Other(describe): I E t✓i S Q_ �EQ R 171 y S i G K `0 S 5": (�G . 4 J- S_Qy�'.►pJ 6 J
7. Attached Plans:Sketch Plan Site Plan Plot Plan
8. Does the site contain a brook, body of water or wetlands? NO ✓DON'T KNOW YES
IF YES: Has a permit been, or need to be, obtained from the Conservation Commission?
Needs to be obtained Obtained , Date issued
CONTINUED ON NEXT PAGE
OK
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